Is Texting with a Therapist Actually Effective? We Investigate

You’ve been feeling off for a while now. It’s hard to fall asleep at night—even when you’re not streaming old Sex and the City episodes—and at work, you find yourself feeling distracted and anxious. Could this uneasy feeling be depression? Maybe it’s tied to something specific, like a breakup or an argument with your mom about your kid’s day care. Regardless of the source of this feeling you can’t shake, you’ve finally come to the decision that you’d like to talk to a therapist. But with your schedule, it’s easier said than done.

And then you remember text therapy—using an app to talk to a psychologist on the phone instead of having to physically show up for an appointment. It seems like a great time-saver. But is texting with a therapist actually effective? Well, the answer is…complicated.

Scientifically, the jury is still out on this one. In theory, texting with a therapist sounds like a great way to save yourself the time of going to an office and sitting down in front of a psychologist for a session. It’s basically the same as shooting a message to your best friend that your boss is being a micromanager again and driving you up a wall, right? Not exactly. The platforms that offer text therapy, like TalkSpace or BetterHelp, set users up with licensed therapists who respond to texts once or twice a day (or less). Unlike your best friend, who typically responds within minutes, your therapist will get back to you when they’re supposed to—which might be hours or a day later—not in real time. So it’s a completely different model than traditional and even video therapy, where a conversation happens in person (so to speak).

Text therapy hasn’t been studied thoroughly enough to know if science can support or refute it, but one small study of 55 people had an interestingly positive conclusion. The 2006 study conducted by researchers at the University of Zurich found that grieving people suffering the loss of a loved one felt better after volunteering for email therapy. This might be because the very act of writing down how you’re feeling is therapeutic in itself, according to the researchers. It might also be easier to write down what you’re thinking than it is to say it out loud (as we know from our junior high days spent journaling our most intimate thoughts). And with more than one million people across ten countries who can say they’ve used TalkSpace since its launch in 2012, there might be something to it.

Well, it depends on who you ask. While the convenience of whipping out your phone every time you need to vent to a therapist sounds like the most convenient form of therapy, it’s not the best way to take care of your mental health, according to therapist Irina Firstein. Think about the last time you were text arguing with your partner and one of you messaged something that was completely misunderstood. When you can’t see a person, you can’t hear the inflections in their voice or the looks on their face that are so important to a meaningful conversation, Firstein tells us. (And no, emojis can’t make up for it.) 

“We all know how texts about emotional issues often get misconstrued,” Firstein says. “Seeing each other and talking in person is an essential part of human communication and interaction. This is why I no longer do therapy on the phone.”

Firstein says that other physical cues, like the look in a person’s eyes and their body language, are critical to understanding what is going on with them emotionally. She equates text therapy to not having one or more of your senses and says that texting with a patient leaves therapists with limited and incomplete information. “Good therapy is very much about the details,” she adds.

This is where the tech world and psychology can mingle happily—over a video chat. Using Skype, FaceTime or any other form of a video call can definitely be an effective way to have a therapy sesh when it’s impossible or too inconvenient to meet with your shrink in person, Firstein says, and it’s also an option on text therapy platforms for people who need it. Video chats with therapists have been widely studied—like in this 2012 study conducted by the Yale School of Medicine, which found that psychiatric episodes and hospitalization rates decreased while the overall mental health of veterans improved dramatically over time thanks to video conferences with therapists.

The only issue here, Firstein notes, is that technology isn’t always as reliable as we’d like it to be. “The only obstacle to a Skype session is a bad connection,” she says. “It’s disruptive and frustrating when it happens, but is mostly not an issue when you find a comfortable place with reliable internet.”

We live in a society where convenience is everything. But when it comes to therapy, the speed and ease of cramming a whole session into two texts could mean depriving ourselves of a higher quality of mental health care.

If you’re truly set in your opinion that you cannot make in-person therapy happen, but you’d really like to speak with a professional about your life, it might be worth a go. Firstein says that people going through trauma should see a therapist in person for the best possible experience, but trying therapy via text won’t necessarily hurt you or your situation. If you’re comfortable with hopping on a video call, it could be your best bet when lying on a therapist’s chaise lounge isn’t an option.

The bottom line? Some therapy is better than no therapy, and that’s something everyone can agree on.